Building on Collaboration to Improve Services for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities: Need Assessment Survey Report Annalisa Ekbladh Center for Disabilities Studies Laura A. Rhoton, Ph.D. Delaware Education Research and Development Center March 2013 Center for Disabilities Studies University of Delaware Newark, DE 19716 Introduction and Methods In late 2011, the Autism Spectrum Disorders project distributed a needs assessment survey to three groups of individuals in Delaware: 1) Parents/guardians of children with autism spectrum disorders; 2) Caretakers of adults with autism spectrum disorders; and 3) Adult self-advocates with autism spectrum disorders. Each group received a slightly different version of the survey. In all, 271 parents/guardians of children with autism spectrum disorders, 91 caretakers of adults with autism spectrum disorders and 19 adult self-advocates with autism spectrum disorders completed the survey. Needs Assessment Survey Instrument The needs assessment survey included questions addressing the following themes: 1) 2) 3) 4) 5) 6) Receiving a diagnosis and follow-up care. Barriers and limitations to accessing health care. Employment challenges for adults with autism spectrum disorders. Family impact. Service needs. Unwanted outcomes. The survey was modeled after a similar survey distributed in Pennsylvania by the Center for Autism Research. Survey questions were modified slightly to apply to Delaware. Modifications included asking questions about Medicaid providers and how far families traveled to see a provider. This survey was distributed in late 2011 in both paper form and online. A paper copy was sent via mail by the Delaware Department of Education and Delaware Division of Development Disabilities Services Services and links to the survey were included on websites for the Center for Disabilities Studies, Autism Delaware, Parent Information Center and Delaware Family & Voices. In addition to including a link on their website, Autism Delaware also sent a link to the survey via their list-serve. Information about the survey and a link was also included in a newsletter published by Project Bridge. A statement at the beginning of the survey instructed parents/guardians of children and caretakers of adults to either fill out a separate survey for each child with autism, or, if only filling out one survey, to complete questions for their oldest child with autism. Adult self-advocates with autism were instructed to answer questions regarding their current situation. Data Analysis Analysis and reporting of the survey data was conducted by staff at the Delaware Education Research & Development Center and modeled after the Pennsylvania Autism Needs Assessment report produced by the Pennsylvania Department of Public Welfare. The data presented are meant to give a picture of the issues surrounding treatment, services, employment outcomes and the impact of having a child with autism spectrum disorder on care takers and family members in Delaware. Data are presented in frequencies and percentages. Examples of substantive interpretations of data are presented below each chart. Diagnosis & Follow-Up Care Autism Diagnosis n=377 1% 1% 21% 17% 0% Asperger's Disorder Autistic Disorder/Autism Childhood Disintegrative Disorder Pervasive Developmental Disorder (PDD/NOS) 60% Rett Syndrome “60% of those who reported a primary diagnosis, reported “autistic disorder/autism…” Autism diagnosis statistics calculated by combining the frequencies for the school age, adult and adult individual surveys. Comments made in the “other” category were not included or re-coded. Mean Age (years) Receiving a Diagnosis 10 9 8 7 6 5 4 3 2 1 0 5 1 2 Pre-elementary (n=29) 3 2 Elementary (n=97) 2 Middle/High (n=138) Age of first concern 2 2 Age of first diagnosis Adult (n=94) “Among the children who are now pre-elementary age, the mean age of first diagnosis was 2.1 years…” Age of first concern and Age of first diagnosis derived from school age and adult surveys (not assessed in adult individual). Mean age was calculated for each age category. Results are depicted in means. I kept the decimal places because it is mean age. Vertical Axis altered to represent 10 point scale. May 31, 2012 Page 1 Diagnosis & Follow-Up Care Where did your child receive his/her diagnosis? 31.9, 32% Physician or Medical Center in Delaware Physician or Medical Center not in Delaware 68.4, 68% “32% of those who reported to have received their diagnosis outside of Delaware…” Percent Data derived from school age and adult surveys (not assessed in adult individual). N=314 45 40 35 30 25 20 15 10 5 0 Prior Diagnoses 42 40 34 35 Preelementary (n=29) 28 20 19 13 14 11 10 66 0 16 12 01 42 00 33 5 0 22 00 4 6 3334 0 Elementary (n=97) 0 3 7 01 56 7 1 4 5 343 5 Middle/High (n=138) Adult (n=94) “35% of parents/guardians of middle/high age students report developmental delays as a prior diagnosis …” Prior diagnoses data derived from school age and adult surveys (not assessed in adult individual). Disorders arranged in ascending order by % reporting. May 31, 2012 Page 2 Diagnosis & Follow-Up Care Number of Professionals Seen Before Getting a Diagnosis 50 38 Percent 40 47 44 43 43 36 33 30 19 20 14 30 21 17 1-2 Professionals 3-4 Professionals 5+ Professionals 10 0 Pre-elementary (n=21) Elementary (n=80) Middle/High (n=122) Adult (n=92) “Among the middle/high age category, 47% saw 1-2 professionals before receiving a diagnosis…” Data derived from school age and adult surveys (not assessed in adult individual). Vertical axis altered to represent a 50 point scale. Age Group Follow up Appointment Referral for Assessment Referral to Treatment Referral to Early Intervention Referral to Support Groups Referral to Website, Literature None Follow-Up Services by Age Group Pre-elementary Elementary (n=97) Middle/High (n=29) (n=138) 8 42 58 27.6% 43.3% 42% 8 34 33 27.6% 35.1% 23.9% 5 16 25 17.2% 16.5% 18.1% 18 49 56 62.1% 50.5% 40.6% 5 32 30 17.2% 33% 21.7% 6 36 40 20.7% 37.1% 29% 3 10.3% 10 10.3% 15 10.9% Adult (n=92) 39 42.4% 22 23.9% 20 21.7% 42 44.6% 21 21.7% 9 9.85 14 14.1% “Of those caring for pre-elementary children, 17.2% are referred for further treatment…” Derived from school age and adult, not assessed in adult individual. Sample size represents the number of people who responded to this question. May 31, 2012 Page 3 Family Impact Unmet Need for Family Support Services 5 Parent Mental Health Counseling 15 14 21 11 Parent Support Group 7 Sibling Mental Health Counseling 11 7 23 27 24 14 Middle/High (n=138) Elementary (n=97) 9 Sibling Support Groups 22 17 10 Family Counseling 21 14 0 5 10 Adult (n=94) 15 20 Pre-elementary (n=29) 24 23 25 30 “27% of caregivers of elementary aged children report an unmet need for parent support groups…” Data derived from question #48 (school age and adult). “Unmet need” calculated by combining ‘my family is receiving but needs more’ and ‘my family is not receiving, but needs.’ 1 Family Impact Barriers to Accesing Family Support Services 282728 30 25 20 14 15 10 5 7 18 15 10 10 5 6 23 20 17 15 11 13 12 8 14 8 3 6 9 17 12 8 0 0 Pre-elementary (n=29) Elementary (n=97) Middle/High (n=138) Adult (n=92) “28% of caregivers of pre-elementary children report a shortage of service providers in the area as a barrier…” Data derived from question #51 (school age and adult). Unmet Need for Care Services- School Age 35 30 32 25 Pre-elementary (n=29) 20 20 15 10 5 16 10 15 10 14 13 Elementary (n=97) Middle/High (n=138) 9 0 Babysitting Afterschool Care Weekend Care “32% of caregivers of elementary aged children report an unmet need for babysitting…” Data derived from question #48 (school age). “Unmet need” calculated by adding ‘my family is receiving but needs more’ and ‘my family is not receiving, but needs.’ 2 Family Impact Unmet Need for Care Services- Adult 20 18 16 14 12 10 8 6 4 2 0 17 10 Respite Care Adult Day Care “17% of caregivers of adults with autism report an unmet need for respite care services…” Data derived from question #48 (adult). “Unmet need” calculated by adding ‘my family is receiving but needs more’ and ‘my family is receiving, but needs.’ Change in Workforce Participation Decreased Work Hours 30 Changed Employer 15 Lost promotion/advancement opportunities 13 Terminated from employment 5 Disciplined/suspended 5 Increased Work Hours 2 0 5 10 15 20 25 “31% of caregivers of children and adults with autism report a decrease in work hours…” Data derived from question #36 (school and adult). 3 30 35 Service Needs - Grant Number: H6MMC22713 - Building on Collaboration to Improve Services for Children and Youth with Autism Spectrum Disorders and Other Developmental Disabilities - University of Delaware’s Center for Disabilities Studies - Annalisa Ekbladh 50 Percent 40 30 20 10 Co-occurring Disorders 43 30 30 23 17 17 9 6 5 4 4 3 3 0 Total n=383 “Of those reporting a co-occurring disorder, 43% report developmental delays as the co-occurring disorder…” Co-occurring disorders statistics were calculated using Question #15 from the school age survey, #15 from the adult survey and #9 from the adult individual. Disorders put in descending order by %. N=383 May 31, 2012 Page 1 Service Needs Data sources: school age, adult, adult individual. Mental Health Counseling 20 17 18 16 16 Percent 14 12 12 12 14 10 Unmet need 8 Dissatisfaction 6 3 4 2 1 0 0 Pre-elementary (n=29) Elementary (n=93) Middle/High (n=129) Adult (n=94) “16% of parents/guardians report an unmet need for relationship counseling for their middle/high school age children …” Relationship Counseling 16 18 16 13 14 Percent 12 10 Unmet need 6 8 6 Dissatisfaction 4 4 2 2 0 0 0 Pre-elementary (n=29) Elementary (n=93) Middle/High (n=129) Adult (n=94) “6% of parents/guardians report dissatisfaction with relationship counseling for their elementary age children …” “Mental health counseling” and “Relationship counseling” (questions 44 and 46, school age and adultsatisfaction not assessed in adult individual). Previously reported in one chart entitled “mental & May 31, 2012 Page 2 Service Needs emotional health services”- statistical problems led to separating the two items out. ‘Unmet need’ is calculated by combining items: “my child is receiving but needs more” and “my child is not receiving, but needs” (Question 44 school age). ‘Dissatisfaction’ is calculated by combining items: “disagree” and “strongly disagree” (Question 45 and 46 school age and adult). Crosstabs were calculated by age category for both ‘Unmet need’ and ‘dissatisfaction.’ Data sources: school age, adult (individual does not assess satisfaction so I left out). Mental Health Counseling 30 25 24 Percent 20 18 15 14 10 12 Receiving 10 5 Not receiving but needs 9 9 3 0 Pre-Elementary (n=29) Elementary (n=97) Middle/High (n=140) Adult (n=113) “12% of parents/guardians report that their elementary age children are not receiving but need mental health counseling….” Mental Health Counseling graph was calculated using Question #44a (crosstab)- categories: “My child is receiving” and “My child is not receiving, but needs.” Age groups: Pre-elementary, ages 0-4; Elementary, ages 5-10; Middle/High, ages 11-21; and Adult, ages 22+. (Data sources: school age, adult and adult individual) May 31, 2012 Page 3 Service Needs Dissatisfaction with Mental Health Counseling 14 11 12 Elementary (n=97) Middle/High (n=138) 12 11 Percent 10 8 6 4 2 0 0 Pre-Elementary (n=29) Adult (n=94) “11.3% of parents/guardians report dissatisfaction with mental health counseling for their elementary age …” Dissatisfaction with mental health counseling calculated using Question#46a (This service is effective in meeting my child’s needs) in school age and adult survey. Crosstabs were used to divide dissatisfaction by age (in school age). Disagree and Strongly disagree categories were combined, results represented in percentages. Functional Therapy Services Speech/language Therapy 70 62 60 54 Percent 50 41 40 Receiving 30 30 Receiving but needs more 21 20 10 0 0 Pre-elementary (n=29) May 31, 2012 1 Elementary (n=97) 15 19 9 8 4 Middle/High (n=138) Not receiving but needs Adult (n=113) Page 4 Service Needs “41% of parents/guardians report that their middle/high school age children are receiving speech/language therapy…” Occupational Therapy 60 55 50 42 Percent 40 30 Receiving 29 25 Receiving but needs more 20 17 10 0 0 Pre-elementary (n=29) 6 11 Elementary (n=97) 12 12 Middle/High (n=138) 4 4 Adult (n=113) Not receiving but needs “25% of parents/guardians report that their elementary age children are receiving, but need more occupational therapy…” Physical Therapy 40 35 34 Percent 30 28 25 Receiving 20 15 15 8 10 7 3 5 0 Receiving but needs more 12 Not receiving but needs 6 6 Pre-elementary Elementary (n=97) (n=29) 1 1 Middle/High (n=138) 1 Adult (n=113) “34% of parents/guardians report that their pre-elementary children are receiving physical therapy services…” Functional therapy (speech/language, occupational and physical therapy) tables calculated using #44b,c and d (school age and adult), #35b, c, and d (adult individual)- items (‘speech/language therapy,’ May 31, 2012 Page 5 Service Needs ‘occupational therapy,’ and ‘physical therapy’). Crosstabs were calculated using age group and need items (listed in chart). Dissatisfaction with Functional Therapy Services 20 17 18 15 16 Percent 14 12 11 10 10 8 Speech/Language Therapy 10 9 7 7 6 5 6 Occupational Therapy 5 4 4 Physical Therapy 2 0 Pre-elementary (n=29) Elementary (n=97) Middle/High (n=138) Adult (n=94) “17% of parents/guardians report dissatisfaction with speech/language therapy that their middle/high school age students receive…” Calculated using question 46 from school age and adult surveys. Dissatisfaction calculated by combining “disagree” and “strongly disagree” responses. Unmet Need for Physical Health Services 14 13 12 10 10 Percent 10 9 8 8 6 6 7 Neurology Services Medication Management 4 2 0 0 Pre-elementary Elementary (n=97) (n=29) Middle/High (n=138) Adult (n=94) “13% of adult individuals with autism report an unmet need for neurology services…” May 31, 2012 Page 6 Service Needs Physical Health Services include items: “neurology services” and “medication management.” Unmet need includes items “my child is receiving but needs more” and “my child is not receiving but needs”combined together (Question 44j and k, school age; Question 44 j and k adult- items not included in adult individual). Dissatisfaction with Physical Health Services 7 7 6 5 5 Percent 5 4 6 5 5 3 Neurology Services 3 Medication Management 2 1 0 0 Pre-elementary (n=29) Elementary (n=97) Middle/High (n=138) Adult (n=94) “7% of parents/guardians report dissatisfaction with neurology services their middle/high school age children receive…” Data derived from question 46 school age and adult. Dissatisfaction calculated by combining “disagree” and “strongly disagree” for neurology services and medication management. May 31, 2012 Page 7 Service Needs Unmet Need for Middle and High School Employment &Transition Services 25 23 Percent 20 15 15 10 5 0 Transition Planning from Pediatric to Adult Healthcare Total n=138 Vocational Training “23% of parents of Middle/High school age children report an unmet need for Vocational Training…” Employment & Transition Services derived from question 44, school age. Unmet (question 44) need calculated by combining “my child is receiving, but needs more” and “my child is not receiving but needs.” Results depicted in percentages for middle/high school students only. Employment & Transition Services for Adults 25 Percent 15 21 19 20 13 17 15 12 11 10 10 Unmet Need Dissatisfaction 5 0 Transitional Planning Vocational Training Career Counseling Supported Employment Total n=92 “Thirteen percent of individuals caring for adults with autism report dissatisfaction with transitional planning…” Unmet need calculated by combining “my child is receiving, but needs more” and “my child is not receiving but needs.” Dissatisfaction was calculated by adding “disagree” and “strongly disagree” question 46. These services only included in adult, not adult individual. May 31, 2012 Page 8 Service Needs Unmet Need for Behavior Support Services 24 25 19 20 Percent 16 15 9 10 7 3 5 3 1 One to one support 11 9 Mobile therapy Case management 3 3 Middle/High (n=138) Adult (n=113) 0 Pre-elementary Elementary (n=97) (n=29) “24% of parents/guardians report an unmet need for one to one support for their elementary age child with autism …” Behavior support services derived from school age, adult and adult individual. Unmet need calculated by combining “my child is receiving, but needs more” and “my child is not receiving, but needs.” Question 44 school age and adult; question 35 adult individual. 18 Dissatisfaction with Behavior Support Services 16 16 14 Percent One to one support 11 12 10 8 8 6 8 4 4 4 2 2 0 0 0 9 Mobile therapy 3 Case management 0 Pre-elementary (n=29) Elementary (n=97) Middle/High (n=138) Adult (n=94) “16% of adults report dissatisfaction with case management….” Behavior support services derived from question 46, school age and adult (satisfaction was not assessed for adult individual). Dissatisfaction calculated by combining “disagree” and “strongly disagree.” May 31, 2012 Page 9 Service Needs Social Skills Training 45 40 38 40 40 35 Percent 30 24 25 Unmet Need 20 14 15 10 10 5 7 Dissatisfaction 0 0 Pre-elementary (n=29) Elementary (n=97) Middle/High (n=138) Adult (n=94) “24% of parents/guardians report an unmet need for social skills training for their pre-elementary age …” Social skills training derived from question 44 and 46, school age and adult. Dissatisfaction calculated by combining “disagree” and “strongly disagree.” Unmet need calculated by combining “my child is receiving, but needs more” and “my child is not receiving, but needs.” Data sources: school age and adult (dissatisfaction not assessed in adult individual, so not using any of that data here). Sexual Health Education 25 20 Percent 20 14 15 10 5 9 2 7 Unmet Need Dissatisfaction 4 0 Elementary (n=97) Middle/High (n=138) Adult (n=94) “20% of parents/guardians report an unmet need for sexual health education for their middle/high age child with autism …” Sexual health education derived from question 44 and 46, school age and adult. Unmet need calculated by combining “my child is receiving, but needs more” and “my child is not receiving but needs.” May 31, 2012 Page 10 Service Needs Dissatisfaction calculated by combining “disagree” and “strongly disagree”- question 46. Adult individual not included in analysis because it does not assess satisfaction levels. Unmet Need for Summer Services 30 27 25 19 Percent 20 15 17 Summer Camp 10 10 9 7 9 Summer School 3 5 0 Pre-elementary (n=29) Elementary (n=97) Middle/High (n=138) Adult (n=94) “27% of parents/guardians report an unmet need for summer camp for their elementary students …” Summer services data derived from “summer camp” and “summer school/ESY” items, from questions 44 and 46, school age and adult. Unmet need calculated by combining “my child is receiving, but needs more” and “my child is not receiving but needs.” Dissatisfaction with Summer Services 12 11 10 9 Percent 8 6 5 3 4 3 3 3 Summer Camp Summer School 2 0 0 Pre-elementary (n=29) Elementary (n=97) Middle/High (n=138) Adult (n=94) “11% of parents/guardians report dissatisfaction with summer school for their elementary students …” May 31, 2012 Page 11 Service Needs Dissatisfaction by combining “disagree” and “strongly disagree”- question 46. Adult individual not represented because dissatisfaction was not assessed. Unmet Needs for Adults Mental & Emotional Health Services 25 20 11 0 15 Individual (n=19) 10 Adult (n=92) 14 5 13 0 0 Mental Health Counseling Relationship Counseling 0 Drug/Alcohol Counseling “11% of adults who answered for themselves report an unmet need for relationship counseling…” Unmet need calculated by combining ‘my child is receiving but needs more/I am receiving but need more’ and ‘my child is not receiving but needs/I am not receiving but need.’ Question 44 adult, question 35 adult individual. Unmet Needs for Adults Employment & Transition Services 40 35 30 25 20 15 10 5 0 16 16 18 Vocational Training 11 5 21 17 Supported Employment Career Counseling 11 Transitional Planning Individual (n=19) Adult (n=92) “34% of all respondents to adult surveys report an unmet need for vocational training…” Employment & transition services items derived from Question 44 adult, question 35 adult individual. Unmet need calculated by combining “receiving, but need more” and “not receiving, but need.” May 31, 2012 Page 12 Service Needs Unmet Need for Adults Functional Therapy Services 30 25 0 20 5 15 10 Individual (n=19) 0 25 17 Adult (n=92) 14 5 0 Speech/Language Therapy Occupational Therapy Physical Therapy Functional therapy items include ‘speech/language therapy,’ ‘occupational therapy’ and ‘physical therapy.’ Question 44 adult, question 35 adult individual. Unmet need calculated by combining “receiving, but need more” and “not receiving, but need.” Educational services, which was depicted in the PA report was not calculated because the items were not present across both the adult and adult individual. 38 Percent 45 40 35 30 25 20 15 10 5 0 Unmet Needs Health and Education Service and Adaptive Equipment 26 25 20 18 16 14 14 14 12 11 11 10 10 9 6 6 Total n=271 May 31, 2012 Page 13 Service Needs Percent Overview of percentage reporting unmet needs by health and education service and adaptive equipment. Unmet need calculated by combining “my child receives, but needs more” and “my child does not receive, but needs.” Sorted in ascending order, reported as percent. School age survey only. 20 18 16 14 12 10 8 6 4 2 0 18 Dissatisfaction with Health and Education Services 16 12 11 10 10 9 8 6 5 5 4 4 3 3 3 3 Total n=271 Overview of percentage of people reporting dissatisfaction with health and education services. Dissatisfaction calculated by combining “disagree” and “strongly disagree” for question 46, school age. Sorted ascending order, reported as percent. School age survey only. May 31, 2012 Page 14 Barriers and Limitations Barriers to Accessing Primary Health Care 25 21 20 17 15 10 5 1616 12 13 10 9 6 5 19 1716 10 9 7 7 8 13 13 10 11 88 11 9 Pre-elementary (n=29) 44 0 0 1 Elementary (n=97) 0 Middle/High (n=138) Adult (n=92) “10% of caregivers of pre-elementary children cite transportation as a barrier to accessing primary health care…”Data derived from question #43 (school age and adult). Barriers to Accessing Dental Services 25 20 15 10 5 0 23 21 17 7485 1010 10 1010 9 12 1012 7 3345 10 1010 8 7 99 Pre-elementary (n=29) 065 Elementary (n=97) Middle/High (n=138) Adult (n=92) “7% of caregivers of pre-elementary children cite transportation as a barrier to accessing dental services…” Data derived from question #43 (school age and adult). 1 Current Employment Status 70 60 Percent 50 26 40 Individuals answering for themselves (n=19) 30 Caregivers answering for adults (n=92) 16 20 10 36 26 14 3 0 Full-time Part-time Looking for a Job “Of those individuals answering the survey for themselves, 26% are employed part-time…” Data derived from adult and adult individual. Adult included response categories: part-time with support, part-time without support, full-time with support, full-time without support. The part-time categories were combined and the full-time categories were combined. Vertical axis altered to represent 70 point scale. Percent Difficulty in the Job Search Process 47 50 45 40 35 30 25 20 15 10 5 0 Finding employment opportunities 47 26 26 Filling out applications Creating a resume Getting an interview 42 42 Interviewing Following up after an interview Adult Individual n=19 “47% of adults (answering the survey for themselves) report difficulty in finding employment opportunities…” May 31, 2012 Page 1 Data derived from adult individual, not assessed in adult. Response categories for each category included “very difficult” and “difficult”- these two were combined. Vertical axis altered to represent 50 point scale. Percent Employment and Transition Services 10 9 8 7 6 5 4 3 2 1 0 9 7 5 3 5 Receiving but needs more 3 Transition Planning Vocational Training 2 2 Career Counseling Not receiving but needs Supported Employment Total n=111 “7% of adults report that the person in question is not receiving but needs transition planning…”Data derived from adult and adult individual surveys. Percent Discomfort in the Work Environment 50 45 40 35 30 25 20 15 10 5 0 47 42 26 Working in a group Asking for help Asking for time off Adult Individual n=19 Vertical axis altered to represent 50 point scale.“26% of adults answering the survey for themselves report difficulty working in a group…”Data derived from adult individual, not assessed in adult. Discomfort in work environment calculated by combining “disagree” and “strongly disagree” categories for each statement on question 23. Asking for help calculated by combining “I feel comfortable asking my peers for information or help” and “I feel comfortable asking an authority figure for information or help.” May 31, 2012 Page 2 Unwanted Outcomes 12 Percent 10 8 ER visit 6 Hospital Admission 4 Police Called 2 0 Pre-elementary Elementary (n=97) (n=29) Middle/High (n=138) Adult (n=92) “9% of caregivers of adults report calling the police…” Data derived from question #27, 28 and 34 (school age and adult). Police Contact by Age 12 9 10 Percent 10 8 Pre-elementary (n=29) 6 Elementary (n=97) 4 2 0 0 0 Police Called 0 1 1 2 Police Warning Issued 1 0 0 2 0 0 1 1 2 0 0 1 Child Served time in Served time in adjudicated jail juvenile detention “9% of caregivers of adults report calling the police…” Data derived from question #34 (school age and adult). Middle/High (n=138) Adult (n=92) Percent Reasons for Hospital Admission by Age 4 3 3 2 2 1 1 0 3 3 3 3 2 2 1 1 0 0 1 1 1 0 1 0 1 1 1 000 0 1 1 Pre-elementary (n=29) 000 Elementary (n=97) Middle/High (n=138) Adult (n=92) “3% of caregivers of elementary children report aggression as the reason for their child’s hospital admission…” Data derived from question #28a (school age and adult). Dissatisfaction with Hospital Care 3 Percent 2 2 2 2 Discharge planning 2 1 1 Inclusion of parent in treatment planning 1 1 1 Quality of treatment 1 0 0 Elementary (n=97) Middle/High (n=138) 0 Adult (n=92) “1% of caregivers of adults with autism report dissatisfaction with the inclusion of parent in treatment planning…” Data derived from question #28b-d (school age and adult). Dissatisfaction calculated by adding ‘dissatisfied’ and ‘very dissatisfied.’